T Nation

52, Obese w/ Hypogonadism

Okay, on the advice of KSMan, here’s what I know so far from the testing. If the testing looks woefully incomplete, it is. I’ve had a miserable time getting all the testing done that’s been needed; getting an estradiol test was like pulling teeth.

-age 52
-height 6 feet
-waist unknown; will supplement
-weight 330-360 (down from 466 before training)

-describe body and facial hair
Little on the body and what there is is light; facial hair has been thick and never a problem. (Grew my first beard at age 11.)

-describe where you carry fat and how changed
Fat all my life, but now average distribution on legs, flabby skin on arms, and the bulk of it as belly fat. Can’t tell if this is due to sitting in wheelchair, or high estradiol.

-health conditions, symptoms [history]
When I was approximately 9 years old, it was discovered that I had an undescended testicle. They shot me full of testosterone at that age and it still didn’t drop. A surgery pulled it down into the canal. Developed body odor and facial hair at 11. Had a weight problem ever since.

12 years ago, weighing the most I ever have, I went into the hospital for a gastric bypass. They had me up and walking the day after the surgery, but by that evening my temperature had skyrocketed to 107 degrees. They did a second surgery that night and found a leak which emptied the contents of my stomach into my blood stream. I went into a medically induced coma for 6.5 weeks and woke up unable to move my lower body. The first year in the nursing home, I was not given adequate protein or rehab, so when I reached 200 lbs., it was a good deal of muscle mass. I was able to get out of there and get the prescribed 225 grams of protein a day, but not after a huge, huge loss of muscle. Although I can move my lower body now and can stand and walk with a walker, I am still unable to walk on my own and in a wheelchair, although nobody can tell me WHY I can’t walk. I firmly believe that if I lose the fat and get some of the leg muscle back, walking will be possible.

—Rx and OTC drugs, any hair loss drugs or prostate drugs ever
On iron gluconate supplement, multivitamin (150 mcg iodine), Fortesta on 2/21, 6 pumps/day (was Testim before), ibuprofen for muscle/joint pain (800 mg), anastrozole (taking 1/2 mg EOD), lisipronil for hbp (10 mg/every other night).

Add Creatine Ethyl Ester (3000 mg before and after workout) and 3 g Acetyl L-Carnitine, 1 g am, lunch and bedtime)

No hair or prostate drugs!

—lab results with ranges (LabCorp)
(initial testing before HRT missing; will edit when received)

12/24/12 (month and a half into treatment:
T, Total_____559.5__________________ng/dL 348-1197
T, Free _______9.8__________________pg/mL_____7.2-24.0 pg/mL

PSA, Total_____0.8__________________ng/mL___Outside range of 4.0-10.0

Cholesterol___126___________________mg/dL___100-199
Triglyceridea__88___________________mg/dL_____0-149

(CBC/Flt shows signs of anemia/small blood cells. Put on iron gluconate supp. this date.)

1/10/13

SHBG 75.9 nmo/L 14.5-48.4 nmo/L
T, Total 658.3 ng/dL 348-1197 ng/dL

2/21/13 (doctor who knows what he’s doing, more or less ordered these)

T, Total___________292.4______ng/dL____348-1197 ng/dL
T, Free______________3.4______pg/mL______7.2-24.0 pg/mL

Prolactin____________7.55_____ng/mL______4.0-15.2 ng/mL

FSH_________________17.4______mIU/mL_____1.5-12.4 mIU/mL
LH__________________18.6______mIU/mL_____1.7-8.6 mIU/mL

Estradiol___________34.0_______pg/mL_____7.6-42.6 pg/mL

-describe diet [some create substantial damage with starvation diets]
Clean diet, 2000 calories/day. Low carbs, occasional cheat on sugar. 225 g. protein/day.

-describe training [some ruin there hormones by over training]
Strength training for 45 minutes, 3x/week w/personal trainer

—testes ache, ever, with a fever?
They’ve actually stopped aching, which worries me. No fever.

—how have morning wood and nocturnal erections changed
Had them really well, sensitive head, first several weeks of TRT. Have since disappeared.

(Now that I’m thinking about it, had extreme sensitivity to cold while on Testim; now on Fortesta, there’s none of that. I just feel like crap, although the brain fog has really lifted.)

Okay, what am I missing testwise? Doctor’s pretty good about ordering the tests if he knows WHY I’m asking. (Estrogens notwithstanding.)

My response to your first post elsewhere:
If your testes are toast, then hCG will not do much. We need your labs with ranges. If LH/FSH are low, hCG has potential. If LH/FSH are mid or high, hCG probably will not do much.

In the advice for new guys sticky, there is a focus on finding causes instead of just treating symptoms.

Your weight and ability to loose weight is greatly influenced by T, T:E, thyroid and cortisol status. So you may not be playing with a full deck in the weight loss game. And nutrients and gut health also influence metabolism. In your case, I would also check IGF-1 levels to see if you are GH deficient.

?UW?

Checking E2 is very important. All the more when you have a lot of fat where T–[aromatase]–>E2.

Post all of your latest labs with ranges.

2/13 labs: That was on transdermal T?

1mg/day anastrozole, another idiot doctor! See the protocol for injections sticky.

Your labs suck.

TT
FT
E2
PSA
CRP
Homocysteine
DHEA
TSH
fT3
fT4
IGF-1
AM cortisol
CBC

You have primary hypogonadism. hCG will have limited effect.

Your cholesterol is way too low! Are you on an extreme low fat diet?

The LH and FSH are screamingly high, so hCG is out then.

UW = University of Washington

Yes, the 2/13 labs are still on transdermals. Was shocked at the level of fall-off.

Ignoring the doctor’s prescribing protocol and going the 1/2 mg./EOD route.

I don’t know what’s happening with the Fortesta – wondering if perhaps my legs, being the most underdeveloped part of my body and the one’s currently not being used much are the wrong place to be using a transdermal gel.

This guy is not that sharp on the subject, but at least he’s better than other so-called specialists at the University of Washington. He’s difficult to see – you make appointments three months in advance – but I’m placing a call today to see if we can’t just go to the next planned step which are the injections.

Oh, and FWIW: The testim, Fortesta AND the anastrozole? All covered by Medicare/Medicaid. In case there are some older guys out there who were wondering.

Nope, low cholesterol is genetic. I didn’t fast like I was supposed to for this test, either. I had a three-egg omlette for breakfast as well. I do try to keep fats low and maintain just the good fats. Is this kicking my ass?

Will take this list to my doctor this week.

Your steroid hormones, including your own Vit-D3 production is all based on cholesterol. Total cholesterol levels 160 and less are associated with increased all-cause mortality.

Inability to absorb T transdermals is a symptom of hypothyroidism. Please read the thyroid basics sticky and come back with info on history of iodine intake from iodized salt and vitamins, and with oral body temperatures.

Couldn’t get most of the requested tests from the general doctor, but the tests that were ordered came back with a surprising result, especially since the libido and other effects are minimal to non-existant:

Estriadol (ignoring dotor’s orignial 1 mg/day anastrozole dosage and going with 1/2 mg EOD): 20 (range: 7.6-42.6).

FSH: 21.2 (range 1.5-12.4)

TOTAL T (repeated): 1399 (range 348-1197)

FREE T: 34.3 (range 7.2-24)

And yes, the nuts ache constantly now.

But with all this – where’s the wood? Considering pregnenolone supplementation.

Seeing UW urologist again on 21 Apr. Will request remainder of the tests then.

Your weight and ability to loose weight is greatly influenced by T, T:E, thyroid and cortisol status.

Read the thyroid basics sticky. Are you getting iodine? What are your body temps? You can do that now. You libido has not come back, so start looking for other problems. More than one weak link.

Cholesterol is still a problem, research that.